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NPI Code Detail

MEDICARE: KATHLEEN S. THIBAULT D.O.

MEDICARE: KATHLEEN S. THIBAULT D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician1613ME

General Provider Information

NPI Number : 1689616260
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN S. THIBAULT D.O.
Provider Business Mailing Address
First Line : 135 PARK ST
Second Line :
City : MILO
State : ME
Zip : 04463-1729
Country : US
Telephone Number : 207-943-7752
Fax Number : 207-943-1002
Provider Business Practice Location Address
First Line : 135 PARK ST
Second Line :
City : MILO
State : ME
Zip : 04463-1729
Country : US
Telephone Number : 207-943-7752
Fax Number : 207-943-1002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 12/13/2007

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Directions to “ KATHLEEN S. THIBAULT D.O.” Practice Location

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